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Prostate biopsy

Authors
Brian M Benway, MD
Gerald L Andriole, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Prostate biopsy is a minimally invasive procedure in which tissue samples are obtained from the prostate gland for the purpose of detecting the presence of cancer. The procedure is typically performed by a urologist in the office setting.

Prostate biopsy techniques and periprocedural management will be reviewed here. Screening for prostate cancer and the clinical presentation, diagnosis, and staging of prostate cancer are discussed elsewhere. (See "Screening for prostate cancer" and "Clinical presentation and diagnosis of prostate cancer".)

INDICATIONS

Although generally considered safe, prostate biopsy is an invasive procedure and recommendations for its use are limited to a defined subset of patients. However, the definition of this subset continues to evolve. Screening the general population for prostate cancer remains a controversial issue, since improved patient outcomes have not been demonstrated [1-4]. When screening is warranted, it is accomplished with digital rectal examination and measurement of serum prostate specific antigen (PSA) levels. (See "Screening for prostate cancer".)

Findings on digital rectal examination that may indicate a need for prostate biopsy include the presence of nodules, induration, or asymmetry. Repeat biopsies may be indicated for inadequate initial sampling or continued high clinical suspicion for prostate cancer after initial negative biopsy based upon rising PSA levels or a variety of other PSA-based parameters (eg, PSA velocity, PSA density). (See "Screening for prostate cancer", section on 'Repeat biopsies' and "Screening for prostate cancer", section on 'Improving the accuracy of PSA' and 'Need for repeat biopsy' below.)

PROSTATE ANATOMY AND IMAGING

The prostate gland is a firm walnut-shaped structure located at the base of the urinary bladder; the apex is caudal and the base cranial. The prostate is composed of both glandular and muscular tissue. Secretions from the prostate, vas deferens, and seminal vesicle empty into the prostatic urethra (ie, section of the urethra that traverses the prostate); each of these structures contributes to the composition of the semen (figure 1).

                                    

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Literature review current through: Nov 2016. | This topic last updated: Thu Jun 09 00:00:00 GMT 2016.
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